Multiple sclerosis (MS) is a disease affecting the fatty sheath that covers nerve fibers in the brain and spinal cord. This sheath, made of a substance called myelin, normally insulates the nerve fibers, allowing nerve impulses to move swiftly and efficiently between brain, spinal cord, and body. In MS, patchy areas of this insulating material are destroyed and replaced by scar tissue, which results in the slowing or blocking of nerve signals. People with MS may experience symptoms such as blurred vision, muscle weakness and spasticity, difficulty walking, poor coordination, bladder problems, numbness, and fatigue. In its most common form, the disease begins between the ages of 20 and 40 with an initial attack of symptoms followed by partial or complete remission. Further attacks usually follow and can eventually lead to progressive disability. Another form of the disease progresses more quickly.

Although the cause of MS isn't known for sure, scientists generally assume that MS is an autoimmune disease in which the immune system attacks the body's own myelin cells. Scientists theorize that something, perhaps a toxin or virus, triggers this autoimmune response in susceptible people. Not everyone appears to be equally susceptible. Gene studies suggest that genetics plays a role in who gets the disease, but other factors seem to be important as well. For example, MS tends to be more common the farther one goes from the equator.1 The disease is also more prevalent in societies with greater dietary intake of meat and animal fat, lower intake of unsaturated fats compared to saturated fats, and lower intake of fish.2-4
Not everyone agrees that all of these factors actually contribute to the disease. Some factors may simply be statistically associated with the actual cause.

There is no cure as yet for MS, but several new drugs—including two forms of the substance interferon ( Avonex and Betaseron), and an unrelated drug, glatiramer acetate (Copaxone)—appear able to reduce the frequency of relapses in people with certain forms of MS and slow the rate of progression of the disease. Other medications reduce the severity of acute attacks or treat specific symptoms such as muscle spasticity.

Proposed Natural Treatments

While there are no well-documented natural treatments for multiple sclerosis, there are a few options that may provide some help.

There is some evidence that changing the type and amount of fat in the diet might alter the course of MS. Based on observations from population studies linking diets lower in fat or saturated fat to lower rates of MS, physician R.L. Swank developed a special low-fat diet for MS in which unsaturated fats replace most saturated fat. This approach, called the Swank diet, has been used by many people with MS. When he analyzed the long-term effects of the diet on his patients, Swank found that those adhering closely to the diet for 20 to 34 years developed significantly less disability than those who ate more saturated fat.5,6
Because these were not controlled trials, they do not actually prove that the Swank diet works. Nonetheless, the possible connection between MS and fatty acids continues to arouse interest, and a variety of essential fatty acids have been proposed as possible treatments for MS (see below). Although a link between fat intake and MS is intriguing, research has not yet provided clear-cut evidence that any of these treatments help.

Linoleic Acid

One of the omega-6 essential fatty acids, linoleic acid, is found in high concentration in sunflower and safflower oil as well as in lower concentrations in most other vegetable oils. Several researchers have investigated whether linoleic acid in the form of sunflower seed oil can help MS, but the results of their research were equivocal.

Three groups of investigators performed
double-blind
studies, using olive oil as a
placebo, to see if linoleic acid supplements could affect the symptoms or course of MS.7-9 Two of these studies (one involving 75 people, the other 116) found that those taking linoleic acid had shorter and less-severe attacks of MS compared to those taking placebo.10,11 However, in the 2 years of the trials, the frequency of attacks and overall levels of disability were not significantly affected. The third study of 76 people found that linoleic acid had no effects on either MS attacks or degrees of disability over 2-½ years, as compared to olive oil.12

Another researcher suggests that these studies may have been too short—that it may take far longer than 2 years for linoleic acid to exert its effects on myelin.13 Olive oil also contains important fatty acids; others have wondered if the olive oil could have been an effective treatment on its own, thereby obscuring the benefits of linoleic acid. Finally, yet another researcher carefully examining the study reports found that linoleic acid might have been effective in those individuals with less severe MS symptoms.14,15

Although interesting, this type of after-the-fact analysis must be interpreted with caution. More studies are needed to confirm whether linoleic acid, taken early in the course of MS or at other times, has the power to prevent, delay, or improve disability. In the three double-blind studies described above, participants received 17 to 20 g of linoleic acid per day, the equivalent of 1 ounce of sunflower seed oil.

Other Essential Fatty Acids

There has been much excitement about other essential fatty acids as treatments for MS, including those found in fish oil (omega-3) and evening primrose oil (omega-6). However, current evidence does not yet support this concept.

Blood tests among people with MS have found lower levels of omega-3 fatty acids in their body fluids and tissues compared to those without MS.16,17
This hints, but does not prove, that taking extra omega-3 fatty acids might help. Only
double-blind, placebo-controlled
studies can show that treatments actually work. (For reasons why, see
Why Does This Database Rely on Double-blind Studies?) Unfortunately, the only meaningful double-blind study of fish oil for MS failed to find evidence of benefit. In this 2-year study of 292 people with MS, comparing fish oil's omega-3 fatty acids with an olive oil placebo, there were no significant differences between the two groups.20 Another study did find possible benefit with fish oil as compared to olive oil in the relapsing-remitting form of MS.45 When used in combination with a low-fat diet, participants given fish oil showed benefits on some measures. However, the study was small, and the results far from definitive. In a larger review of 3 studies, fish oil combined with a low-fat diet was found to be ineffective at reducing relapses anddisability, and improving quality of life.51

Similarly, while some researchers have suggested that
gamma-linolenic acid (GLA) might be beneficial in MS,21 so far what little evidence there is remains more negative than positive.22-24

For more information, including dosage and safety issues, see the
Fish Oil
and
GLA
articles.

Threonine

Early evidence suggests that threonine, a naturally occurring amino acid, might be able to decrease the muscle spasticity that often occurs with MS.

Two small double-blind studies found a modest but
statistically significant improvement in muscle spasticity among people who took threonine compared to those who took placebo.25,26 In one study of 26 people with MS, the improvement was so slight after 8 weeks of treatment that it was detectable by doctors but not by the participants themselves.27 In the other, both researchers and a few of the 33 participants noticed improvement after 2 weeks of treatment, with some individuals reporting fewer spasms and milder pain.28
Interestingly, this shorter trial that showed more improvement also used lower doses—6 g daily of L-threonine, as opposed to 7.5 g daily of threonine. No significant side effects were noted in either study.

Vitamin B
12

Because several studies have found MS to be occasionally associated with vitamin B
12 deficiency,29-31
and lack of B
12
can cause neurological problems on its own, some doctors recommend that people with MS be screened for this condition. One highly preliminary study suggested that massive doses of B
12 could improve certain test results ("evoked potentials"), but not disability, in people with chronic progressive MS.33
A double-blind study of 50 people with MS found that high doses of injected
hydroxocobalamin, a form of B
12, did not affect the course of disease or number of relapses.34

For more information, including dosage and safety issues, see the
Vitamin B12
article.

Vitamin D

Our bodies normally obtain vitamin D in one of two ways: through our diet or through exposure of our skin to the sun. More than one group of researchers has noted that areas with less sunshine tend to have a higher incidence of MS, unless the residents eat more fish that is rich in vitamin D.35-38 This has led to a theory that vitamin D might confer some protection against MS. So far, no human studies have adequately tested this hypothesis, although one poorly designed study did investigate a combination of calcium, magnesium, and vitamin D given in the form of cod liver oil, and found hints of benefit.39

For more information, including dosage and safety issues, see the
Vitamin D
article.

Phenylalanine and TENS

Phenylalanine is an essential amino acid, meaning that we need it for life and our bodies can't manufacture it from other chemicals. We normally obtain all the phenylalanine we need for nutritional purposes from high-protein foods. Supplemental phenylalanine has been studied for MS only in combination with another treatment called transcutaneous nerve stimulation (TENS), a portable electrical device used to decrease pain and muscle spasticity.

Two small double-blind trials compared phenylalanine to placebo among a total of 16 people with MS being treated with TENS.40
In both studies, those treated with phenylalanine and TENS experienced less muscle spasticity, fewer bladder symptoms, and less depression after 4 weeks of treatment than those treated with TENS and placebo. These findings are somewhat difficult to interpret, but tend to suggest that phenylalanine may be helpful in MS. For more information, including dosage and safety issues, see the full
Phenylalanine
article.

Other Treatments

A special form of
magnet therapy called PEMF (pulsed electromagnetic field therapy) has shown some promise for MS. In a 2-month, double-blind, placebo-controlled study, 30 people with multiple sclerosis applied a real or a fake PEMF device to one of three acupuncture points on the shoulder, back, or hip.44 The study found statistically significant improvements in the treatment group, most notably in bladder control, hand function, and muscle spasticity. A review of 6 studies supported that magnetic metal mats used for 8 minutes, 2 times per day may be useful in decreasing fatigue, but not depression associated with MS. There was inconclusive evidence that it helped with other symptoms, such as bladder control, cognition, fatigue, or mobility.51

A small double-blind trial suggests that neural therapy, a treatment related to
acupuncture, might be helpful for MS.42
In addition, some evidence hints that
reflexology might be helpful for parasthesia (sensation of burning, tingling, prickling, or numbness). A review evaluating 4 studies found improvement with 11 weeks of therapy.48,51

Use of bee stings or injected bee venom for MS has generated a great deal of interest over the years, despite a lack of reliable research supporting its use. The one meaningful study, reported in 2005, failed to find any benefit.46

Although
ginkgo is sometimes suggested as a treatment for MS, there is no meaningful evidence that it works. One study reported as showing benefit was actually too small to provide meaningful results.49 Another double-blind study examined ginkgolide B, a chemical in ginkgo, for treating MS attacks, but found no evidence of benefit.43 A 2012 randomized trial of 121 patients with MS found that ginkgo biloba did not improve cognitive function on neuropsychological test scores compared to placebo.50 Simlar results were found in a review of 4 studies though, ginkgo was associated with improving fatigue symptoms after 4 weeks when compared to placebo.51

29.
Baig SM, Qureshi GA, Minami M. The interrelation between the deficiency of vitamin B12 and neurotoxicity of homocysteine with nitrite in some of neurologic disorders.
Biogenic Amines. 1998;14:1-14.

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